Pothole Evidence
POTHOLE DAMAGE
POTHOLE REPORT
Date
Visibility
Daylight
Night/Dark
Location (Red=Damage, Black=Hazard)
Vehicle Model
Damage Type
(Multi)
Rim/Wheel
Tyre
Suspension
Bodywork
Other
Evidence Photos
1. POTHOLE
2. DAMAGE
3. RECEIPT (IMAGE/PDF)
Repair Cost (£)
Lost Work (£)
Recently Repaired?
No
Yes - Recently
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